PSYCHIATRY Flashcards
(543 cards)
MENTAL HEALTH ACT 1983
What does the main part of the MHA allow for?
- ‘Sectioning’ = compulsory admission to hospital for those that are mentally ill.
- Drs should persuade pts to come in voluntarily if they have capacity, but not always possible (esp if they lack insight)
MENTAL HEALTH ACT 1983
What are the main principles of the MHA?
- Respect for pts wishes + feelings (past + present)
- Minimise restrictions on liberty
- Public safety
- Pts well-being + safety
- Effectiveness of treatment
MENTAL HEALTH ACT 1983
What is does an individual have to show to be sectioned?
- Evidence of MH disorder
- Evidence they’re serious risk to self, safety or others
- Evidence there is good reason to warrant attention in hospital
- Appropriate treatment must be available for a S3
MENTAL HEALTH ACT 1983
What is a…
i) section 12 approved dr?
ii) approved mental health professional?
i) ≥ST4 Dr who has done extra training in MH to get S12 approved to section pts
ii) AMHPs are often social workers who have done extra training in MH
MENTAL HEALTH ACT 1983
Who can remove sections?
- Consultant psychiatrist
- MH review tribunal (MHT) if pt disagrees w/ section
- Nearest relative can make an order to discharge pt from hospital with 72h written notice
MENTAL HEALTH ACT 1983
If a relative requests a section removal how can the clinician respond if they disagree?
- Issue a barring report within 72h which stops discharge up to 6m from then
- Can still apply to MHT if disagrees
MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved for a Section 2?
P – admission for assessment, treatment can be given w/out consent
D – 28d, cannot be renewed, can be converted to S3
L – anywhere in community (airports, jail, A+E, etc)
Prof – 2 Drs (1x S12), 1 AMHP, or nearest relative
MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved for a Section 3?
Who is involved if a pt is medicated without consent?
P – admission for treatment
D – 6m, can be renewed
L – anywhere in community
Prof – 2 Drs (1x S12), 1 AMHP, nearest relative
Second opinion appointed doctor (SOAD) – after 3m SOAD reviews if medication w/out consent is necessary
MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved, evidence needed for a Section 4?
P – emergency order
D – 72h
L – anywhere in community
P – 1 S12 Dr, 1 AMHP, nearest relative
E – same as S2 but only in an urgent necessity when waiting for a second dr (for a S2) would lead to undesirable delay/outcome
MENTAL HEALTH ACT 1983
Where can you apply a S5?
What can the team not do?
- Voluntary pt in hospital that wants to leave (NOT A+E as not admitted)
- Coercively treat the pt
MENTAL HEALTH ACT 1983
What is the purpose, duration + professionals involved for a Section 5(2)?
P – Drs holding power, allows for S2/3 assessment
D – 72h
Prof – 1 Dr (usually in charge of their care or nominated deputy
MENTAL HEALTH ACT 1983
What is the purpose, duration + professionals involved for a Section 5(4)?
P – nurses holding power until Dr attends to assess
D – 6h
Prof – 1 registered nurse
MENTAL HEALTH ACT 1983
What are the 2 police sections and their differences? What is the duration and purpose of these?
- S135 – needs magistrates court order to access pts home + remove them
- S136 –person suspected of having mental disorder in a public place
D – 24h (extend to 36h if intoxicated but should be seen sooner)
P – taken to place of safety (local psych unit, police cell) for further assessment
ECT
What are the reasons why ECT can be done?
When is electroconvulsive therapy (ECT) recommended?
- Rapid improvement of severe Sx after adequate trial of other Tx proven ineffective and/or condition potentially life threatening
- Severe mania or depression, suicide risk, catatonia, Rx resistant psychosis
ECT
What are some contraindications to ECT?
- NO absolute, all relative
- General anaesthesia (reactions)
- Cerebral aneurysm
- Recent MI, arrhythmias
- Intracerebral haemorrhage
ECT
What are some adverse effects of ECT?
- Short-term retrograde amnesia
- Headache
- Confusion + clumsiness
DEPRESSION
What is depression?
How common is it?
- Persistent low mood ± loss of pleasure in activities – unipolar depression.
- 2–6% prevalence globally, F>M but men more likely to be substance misusers + commit suicide
DEPRESSION
What are 2 theories speculating the causes of depression?
- Stress vulnerability = someone with high vulnerability will withstand less stress before becoming mentally unwell
- Monoamine hypothesis = depression caused by deficiency in monoamines (serotonin, noradrenaline) hence why Tx works
DEPRESSION
What are the biological causes of depression?
- Personal/FHx + genetics
- Personality traits (dependent, anxious, avoidant)
- Physical illness (hypothyroid, anaemia, childbirth)
- Iatrogenic (beta-blockers, steroids, substance misuse)
DEPRESSION
What are the…
i) psychological
ii) social
causes of depression?
i) Disrupted relationships, child abuse, poor coping mechanisms
ii) Low socioeconomic status, poor social support, discrimination, divorce, refugee
DEPRESSION
What are some risk factors for depression?
- Physical co-morbidities, esp. chronic + painful (MS, stroke, DM)
- Genetics + FHx, female, older age, substance abuse
- Traumatic events (+ve/-ve) like divorce/marriage, (un)employment, poverty, loss
- Adverse childhood experiences like abuse, poor parent relationships
DEPRESSION
What are the 3 diagnostic criteria for depression?
- Sx present most days ≥2 weeks + change from baselines
- Sx not attributable to other organic or substance causes
- Sx impair daily function + cause significant distress
DEPRESSION
What are the three core symptoms of depression?
- Low mood
- Anhedonia
- Anergia
DEPRESSION
What are some psychological symptoms of depression?
- Guilt, worthlessness, hopelessness
- Self-harm/suicidality
- Low self-esteem